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Off-pump bypass surgery--experience of 250 cases
L Wiklund1, G Brandrup-Wognsen, M Bugge
1Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. lars.wiklund@medfak.gu.se
Insights
Off-pump coronary artery bypass grafting minimizes surgical trauma by avoiding extracorporeal circulation. This safe procedure shows promising early results, with low mortality and high graft patency, though long-term outcomes require further study.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
Background:
- Coronary artery bypass grafting (CABG) traditionally involves extracorporeal circulation, which can increase surgical trauma.
- Minimizing surgical trauma is a key goal in cardiac surgery to improve patient outcomes.
Purpose of the Study:
- To evaluate the safety and early efficacy of off-pump coronary artery bypass grafting (OPCABG).
- To assess the need for intensive care resources in patients undergoing OPCABG.
Main Methods:
- A prospective study of 250 patients undergoing OPCABG between April 1996 and October 1998.
- Patients had varying degrees of coronary artery disease (1-vessel, 2-vessel, or 3-vessel).
- Surgical approaches included sternotomy or anterior mini-thoracotomy; early postoperative coronary angiography was performed in a subset of patients.
Main Results:
- Perioperative mortality was low at 0.4%.
- Early graft patency was high at 96.5% in the first 87 patients studied.
- Mean intensive care unit (ICU) time was 12 hours, and mean in-hospital stay was 7 days, indicating limited resource utilization.
Conclusions:
- Off-pump coronary artery bypass grafting is a safe procedure with low perioperative mortality and reduced need for intensive care resources.
- The technique effectively minimizes surgical trauma by avoiding extracorporeal circulation.
- Long-term outcomes and graft durability warrant further investigation.
Abstract:
From April 1996 to October 1998, 250 patients with a mean age of 63 years (31-86 years) underwent coronary artery bypass grafting using the off-pump technique. The prime reason for using this technique was the need to minimize the surgical trauma by avoiding extracorporeal circulation. Fifty-seven percent of the patients had 1-vessel disease, 39% had 2-vessel disease and 4% 3-vessel disease. Sternotomy was performed in 196 patients and an anterior mini-thoracotomy in 54 patients. The mean number of coronary anastomoses was 1.5. Perioperative mortality was 0.4%. The first consecutive 87 patients underwent an early postoperative coronary angiography (days 1-5) revealing a graft patency of 96.5%. Five out of the 7 patients with occluded grafts subsequently underwent another intervention (surgical revascularization in 4 patients and percutaneous transluminal coronary angioplasty in one); 1.2% developed transmural myocardial infarction and 2.8% were reoperated upon for bleeding. The mean time of ventilatory support was 2.5+/-0.5 h. The mean ICU time for all patients was 12 h (0-10 days). The mean in-hospital time was 7 days (2-30 days). Coronary artery bypass surgery without the use of extracorporeal circulation is a safe procedure that can be performed with limited need for intensive care resources. However, long-term results remain to be investigated.